Ethical Considerations and Types of Group Therapy

Although people deal with groups all the time, professionally, they’re some ethical concerns and issues to be mindful of:

Major Ethical Issues in Group Work

• The training or lack of with group leaders
• Screening potential group members (e.g., informed consent statement)
• Rights of group members (e.g., confidentiality, involuntary group)
• Personal relationships between group members and leaders (e.g., dual/multiple relationships)
• Personal relationships among group members

Most of the time, group therapy is safe and fun, but most concerns occur if the therapist is practicing outside of the general rules and guidelines. Another great rule of thumb, is if it seems wrong or illegal, just don’t do it or seek consultation.

Actions to Prevent Lawsuits

• Screening to reject inappropriate potential group members
• Spending extra time at the beginning of the first group session to discuss group rules and group members’ responsibilities
• Following the ethical codes of professional organizations to which one belongs
• Practicing only those theories and techniques in which one has actual expertise
• Obtaining consent or contracts in writing from members (or, in case of minors, their parents)
• Warning members about the importance of confidentiality and the exceptions in which member confidentiality will have to be broken
• Staying abreast of recent research, theory, and practice techniques within one’s specialty
• Empowering members to evaluate their own progress and be in charge of their own progress
• Obtaining regular peer supervision of one’s work
• Following billing regulations and record-keeping practices to the letter of the law

-Corey et al., 2015; Paradise & Kirby, 1990; Van Hoose & Kottler, 1985; Wheeler & Bertram, 2015

Key Definitions with Ethics 

Professional Liability Insurance: insurance designed specifically to protect a group worker from financial loss in case of a civil suit. Professionals who work with groups should carry it.

Dominant Values of Ethics

• Autonomy: Promotion of self-determination. Power to choose one’s own direction in life. In groups, it is important that members feel they have a right to make their own decisions.
• Beneficence: Promoting the good of others. In groups, it is assumed that leaders and members will work hard for the betterment of the group as a whole.
• Nonmaleficence: Avoiding doing harm. Members of groups must be sure the changes they make in themselves and the help they offer others are not going to be damaging.
• Justice: Fairness and equal treatment of all people. Implies that everyone’s welfare is promoted and that visible differences in people, such as gender or race, do not interfere with the way they are treated
• Fidelity: Loyalty, duty, and keeping promises, and honoring commitments. In group work, it involves stating up from what the group will focus on and then keeping the pledge
• Veracity: Truthfulness. In group work, veracity is important in all phases of the group’s development.

Types of Group Therapies for PMHNP

Family Psychoeducation Groups: offered to improve patient outcomes. The goal of these groups is to assist the family in promoting compliance with medication and successful re-entry back into the community. The topics of this group include information about mental disorders and co-occurring disorders and also help the family member improves their coping skills and quality of life.  These groups can include other members or a single-family unit.

Psychodrama: members become “actors” in Life situation scenarios. It provides a safe and supportive place for the protagonists to confront and resolve issues. Roles:

• Protagonist: the main character with issues to resolve
• Other actors: the characters that the protagonist has unresolved issues with
• Audience: non-acting group members
• Director: the group leader

Medication Management: discussing risks, pros/cons, complications, medications with schedules such as insulin, and how meds may affect other conditions…etc.

Psychoeducational: help teach patients, families, and communities about mental disorders, medications, managing behaviors such as anger and agitation, coping/accepting the mental illness, treatments, and related issues. These groups a time-limited and specific to one focus area at a time but can be very resourceful. Members can learn from each other, create a network, and are more open to asking each other questions.

Reality Orientation Groups: offered to confused patients or those with an impaired reality. The goal is to help patients orientate and maintain contact with their environments. Props such as clocks and other common items are used to stimulate recognition. (example from YouTube )

Therapeutic Activity Groups: most common for children and preadolescence, to take advantage of the child’s natural ability to express their feelings through play activities. Effective for: learning competition, getting along with other people, goal setting, and improving social behaviors.

Other groups include (re)Socialization, reminiscence, assertive and relaxation training, modeling, communication skills, problem-solving, and special populations.